Provider Demographics
NPI:1700917986
Name:ACOSTA-CUEVAS, JOSE ANTONIO (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:ACOSTA-CUEVAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10232 STATHOS DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5995
Mailing Address - Country:US
Mailing Address - Phone:916-625-4966
Mailing Address - Fax:916-685-5619
Practice Address - Street 1:9340 W STOCKTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8014
Practice Address - Country:US
Practice Address - Phone:916-683-3775
Practice Address - Fax:916-683-3164
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD505551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice